Atherosclerosis and estrogen replacement therapy

Cardiovascular morbidity and mortality increase after menopause. There has been reluctance to use estrogen replacement therapy (ERT) for treating women with a high risk of cardiovascular disease because of adverse experience in two areas: (1) The Coronary Drug Project administered high doses of estrogen to male survivors of MI, which was associated with excess coronary and thromboembolic events. (2) Studies of OC use revealed an increased incidence of heart attacks among women over the age of 35 years who smoke. Eight case-control studies have examined the effect of estrogen replacement therapy on cardiovascular events; five have shown a protective effect. Eleven of 19 reports have found a protective effect. Ten of 11 cohort studies have found a protective effect. One randomized study (by Nachtigall et al) found a beneficial effect. Angiographic studies at the University of Tennessee/Baptist Memorial Hospital, Memphis have examined the relative risk for coronary artery disease for postmenopausal women relative to estrogen use. Cases with significant coronary angiograms. Logistic regression analysis showed that estrogen use had a statistically significant independent protective effect against coronary atherosclerosis. These observations have been confirmed by three subsequent studies. The same study group also examined the effect of estrogen replacement on survival of patients who underwent coronary arteriography at baseline. Of 23,190 patients undergoing arteriography, 2,268 women were eligible for long-term study. While patients who were initially free of coronary artery lesions did not have a significant reduction of mortality when given estrogen replacement, a significant reduction of all-cause mortality was observed in those groups with coronary artery disease who received estrogens.(ABSTRACT TRUNCATED AT 250 WORDS)